Bowel preparation for colonoscopy in patients with surgically altered anatomy: a narrative review and institutional protocol

Colonoscopy is a vital diagnostic and therapeutic procedure for diseases affecting the rectum, colon, and terminal ileum. In patients who have undergone colorectal surgery, postoperative colonoscopy is frequently required for purposes such as colorectal neoplasia surveillance. However, administering bowel preparation in this population poses significant challenges for patients, caregivers, and the endoscopy team, including gastroenterologists and nurses. Despite these challenges, there is limited peer-reviewed guidance on optimal bowel preparation strategies for these patients. This review summarizes the current data on bowel preparation in patients with surgically altered anatomy, identifies key challenges, addresses existing gaps in knowledge, and presents a tailored approach to bowel preparation in this population based on institutional protocol. In addition, we propose future directions for research and quality improvement to enhance outcomes in this cohort.